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Burnett County 7410 Go. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3 = Z <br /> r <br /> m <br /> OWNER TELEPHONE g� — 4 q p —, <br /> m <br /> MAILING ADDRESS L�( 7 q�� (� .-.�o I 4jam- <br /> �W�b n O <br /> i 1 r � � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) �� 501 — ri <br /> �2 <br /> DWELLING/BUILDING ❑ GARAG /ACCESSORY STRUCTURE W ADDITION ❑ lq 0 �. <br /> TYPE OF PERMIT(S): Q , <br /> FILLING/GRADING ❑ CAMPING UNIT ,❑ SUBDIVISION ❑ a <br /> �6�z �STRUCTURE/ADDITION USE: Li' �� q /'/'1 0 <br /> (Home Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> d <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Y <br /> NORTH(N). w o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C) BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ) <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS J <br /> MUST BE SIGNED AND DATED BY THE OWNER. f o F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ! o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q) <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> C1 C: M DODO M <br /> 6. habitation. 0 � 3 a 0 3 a a <br /> 0 oCDc0 � <br /> Z c to <br /> �. OP m m <br /> I declare that this a licatior, ,..._.__... „ ,.vu�,e nay ueen ezammea o me and to the best of m p <br /> PP a ...., .............a,,,. y �.. I Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofCL <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m c my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I a i d i o i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other n C <br /> authorized person to h e access to the above described premises at any reasonable time for the purpose of inspection. CD n <br /> -n <br /> CD m D <br /> SIGN HERE <br /> (signature ofown Iding contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> (:Wa3'7- M7L/ <br /> O N UI W W N O <br /> O VI O Cn (T Ul O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />